{"id":500,"date":"2023-02-16T20:53:08","date_gmt":"2023-02-16T20:53:08","guid":{"rendered":"https:\/\/www.crchc.org\/?page_id=500"},"modified":"2024-04-01T10:02:41","modified_gmt":"2024-04-01T14:02:41","slug":"patient-registration-forms","status":"publish","type":"page","link":"https:\/\/www.crchc.org\/patient-registration-forms\/","title":{"rendered":"Patient Registration Forms"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text]<img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-504 size-full\" src=\"https:\/\/www.crchc.org\/wp-content\/uploads\/2023\/02\/form.jpg\" alt=\"\" width=\"1225\" height=\"465\" srcset=\"https:\/\/www.crchc.org\/wp-content\/uploads\/2023\/02\/form.jpg 1225w, https:\/\/www.crchc.org\/wp-content\/uploads\/2023\/02\/form-300x114.jpg 300w, https:\/\/www.crchc.org\/wp-content\/uploads\/2023\/02\/form-1024x389.jpg 1024w, https:\/\/www.crchc.org\/wp-content\/uploads\/2023\/02\/form-768x292.jpg 768w, https:\/\/www.crchc.org\/wp-content\/uploads\/2023\/02\/form-260x99.jpg 260w, https:\/\/www.crchc.org\/wp-content\/uploads\/2023\/02\/form-50x19.jpg 50w, https:\/\/www.crchc.org\/wp-content\/uploads\/2023\/02\/form-150x57.jpg 150w\" sizes=\"(max-width:767px) 480px, (max-width:1225px) 100vw, 1225px\" \/>[\/vc_column_text][vc_column_text]<\/p>\n<h2 style=\"text-align: center; color: #00305b; letter-spacing: 2px; margin-bottom: 0px;\"><strong>PATIENT REGISTRATION FORMS<\/strong><\/h2>\n<h3 style=\"font-weight: 100; text-align: center; border: none;\">Access patient registration forms below.<\/h3>\n<p>[\/vc_column_text][vc_row_inner equal_height=&#8221;yes&#8221; gap=&#8221;10&#8243;][vc_column_inner width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1676581422756{background-color: #f4f4f4 !important;border-radius: 1px !important;}&#8221;][vc_column_text]<\/p>\n<h4 style=\"text-align: center; color: #00305b;\">CRCHC Patient Registration Form<\/h4>\n<ul class=\"meunx\">\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/CRCHC-Patient-Registration-Form-English-11-7-2022.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/li>\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/CRCHC-Patient-Registration-Form-Spanish-11-7-2022.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1676581426963{background-color: #f4f4f4 !important;}&#8221;][vc_column_text]<\/p>\n<h4 style=\"text-align: center; color: #00305b;\">Sliding Fee Application<\/h4>\n<ul class=\"meunx\">\n<li><a href=\"\/wp-content\/uploads\/2024\/04\/Updated-SFS-7-26-2022.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/li>\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/Updated-SFS-Spanish-6-13-2022.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner equal_height=&#8221;yes&#8221; gap=&#8221;10&#8243;][vc_column_inner width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1676581422756{background-color: #f4f4f4 !important;border-radius: 1px !important;}&#8221;][vc_column_text]<\/p>\n<h4 style=\"text-align: center; color: #00305b;\">Medical Record Release Form<\/h4>\n<ul class=\"meunx\">\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/Medical-Record-Release-8-2022-english.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/li>\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/Medical-Record-Release-8-2022.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1676581426963{background-color: #f4f4f4 !important;}&#8221;][vc_column_text]<\/p>\n<h4 style=\"text-align: center; color: #00305b;\">HIPPA Insurance Consent<\/h4>\n<ul class=\"meunx\">\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/HIPPA-Insurance-Consent-English-6-23-2022.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/li>\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/HIPPA-Insurance-Consent-Spanish-9-7-2022.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner equal_height=&#8221;yes&#8221; gap=&#8221;10&#8243;][vc_column_inner width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1676581422756{background-color: #f4f4f4 !important;border-radius: 1px !important;}&#8221;][vc_column_text]<\/p>\n<h4 style=\"text-align: center; color: #00305b;\">Patient No Show Policy<\/h4>\n<ul class=\"meunx\">\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/Patient-copy-No-show-policy-English-7-11-2022.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/li>\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/Patient-copy-No-show-policy-Spanish-6-13-2022.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1676581426963{background-color: #f4f4f4 !important;}&#8221;][vc_column_text]<\/p>\n<h4 style=\"text-align: center; color: #00305b;\">Social History Form<\/h4>\n<ul class=\"meunx\">\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/Social-History-English-Updated-9.11.2020.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/li>\n<li><a href=\"\/wp-content\/uploads\/2023\/02\/CRCHC-Patient-Registration-Form-Spanish-6-13-2022.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text][\/vc_column_text][vc_column_text] PATIENT REGISTRATION FORMS Access patient registration forms below. [\/vc_column_text][vc_row_inner equal_height=&#8221;yes&#8221; gap=&#8221;10&#8243;][vc_column_inner width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1676581422756{background-color: #f4f4f4 !important;border-radius: 1px !important;}&#8221;][vc_column_text] CRCHC Patient Registration Form English Spanish [\/vc_column_text][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243;<span class=\"excerpt-hellip\"> [\u2026]<\/span><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.crchc.org\/wp-json\/wp\/v2\/pages\/500"}],"collection":[{"href":"https:\/\/www.crchc.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.crchc.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.crchc.org\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.crchc.org\/wp-json\/wp\/v2\/comments?post=500"}],"version-history":[{"count":22,"href":"https:\/\/www.crchc.org\/wp-json\/wp\/v2\/pages\/500\/revisions"}],"predecessor-version":[{"id":2161,"href":"https:\/\/www.crchc.org\/wp-json\/wp\/v2\/pages\/500\/revisions\/2161"}],"wp:attachment":[{"href":"https:\/\/www.crchc.org\/wp-json\/wp\/v2\/media?parent=500"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}